Actinomycotic Infection of Spine - A Rare Disease with Diagnostic Challenge, an Update on Spinal Infection.

INTRODUCTION: We are reporting a rare case of lumbar spinal actinomycosis with superficial discharging sinuses in an elderly female. CASE REPORT: A 56-year-old female came in outpatient with chief complaints of low back pain radiating to both buttocks, burning sensations to both lower limbs. Magnetic resonance imaging (MRI) re-vealed signal intensity changes suggestive of patchy marrow edema present over the L2 to S1 vertebra. Surgery was performed in the form of laminectomy and decompression by posterior approach and tissue was collected from right sacral ala. Contrast MRI showed patchy areas of marrow signal ab-normality L1, L2, L4, and L5 vertebra and adjoining end plates of L5, S1, and S2 segments. Ring en-hancing lesions at L2 and L3 levels. The patient underwent revision surgery. Histopathology revealed clumps of basophilic filamentous bacteria in a vaguely rosette-like configuration surrounded by acute inflammatory cells, characteristic of actinomycosis. CONCLUSION: Actinomycotic infections of spine are a rare cause of spinal infections but should be kept in mind once the tubercular infection is ruled out. The definitive diagnosis of actinomycosis can be made by finding actinomycetes in the pus from affected tissue.

Non-contiguous extensive multifocal spinal tuberculosis- treating uncommon scenarios.

Noncontiguous multiple tuberculous spondylitis is not uncommon, and most of the reported cases have lesions only on 2 or 3 levels. To the best of our knowledge, multifocal extensive spinal TB involving the whole spine is rarely reported in the literature, which may be presented as asymptomatic and have a higher incidence of neurological complications. It is noticeable that the possibility of TB is considered for any skip lesions involving the spine cautiously. Diagnosis and treatment at early stages would resolve the neurological deficits without operation.

Salmonella Typhi dorsolumbar spondylodiscitis mimicking tuberculosis - An interesting case report.

Background: Salmonella rarely causes spinal infections in patients other than those who are immunocompromised or have sickle cell anemia. Further, most cases occurring in healthy individuals have preexisting gastrointestinal infections. Here, we present a case of pyogenic spondylodiscitis attributed to Salmonella Typhi, in an immunologically normal patient without gastrointestinal pathology. Case Description: A 58-year-old diabetic female complained of lower back pain and malaise. The workup for spinal tuberculosis was negative, but her MRI revealed findings consistent with pyogenic spondylodiscitis (e.g., destruction and instability) for which she required posterior spinal surgery. The organism proved to be S. Typhi; she was treated for 2 months and followed-up for 2 years. Conclusion: Salmonella spondylodiscitis should be considered among the differential diagnoses for patients with features of infective spondylodiscitis. Culture-specific antibiotics are the cornerstone of treatment, along with appropriate and timely surgery.